Clinical Trial Summary
In 1967 spinal cord stimulation (SCS) for the treatment of chronic neuropathic pain was
established. Today various pain syndromes like the failed back surgery syndrome (FBSS), the
complex regional pain syndrome (CRPS), ischemic pain or phantom limb pain are treated with
SCS. The development of this technique based on the so called "Gate Control Theory" which
states that stimulation of the mechanosensitive Aβ fibers suppresses the transmission of pain
stimuli via the pain-sensitive C fibers to the brain in the spinal cord. Conventional SCS
consists of periodically emitted tonic stimuli with a frequency between 30 and 120 Hz. During
implantation, the electrodes are placed in the epidural space in such a way that the
paraesthesia caused by nerve stimulation covers the painful area (dermatome), thus relieving
the pain. In 2010 de Ridder et al. published an article presenting the so called "Burst
Stimulation" where series of high-frequency impulses are released at defined time intervals
(frequency: 40 Hz with peaks of 500 Hz per volley). Compared to the tonic SCS the burst
technique is more effective and in most cases no paraesthesia is reported. However, potential
effects of SCS stimulation on other organ systems have only been insufficiently
examined.Especially possible effects of SCS on the glucose metabolism has not been
investigated so far. However, it is important to investigate a possible effect for two
reasons: SCS could cause severe hypoglycemia which must be avoided. Furthermore, if SCS
affects blood sugar levels, it is also of interest what mechanisms are involved and how this
knowledge can be used to control elevated blood glucose levels.
The present study is a pilot. The investigators want to examine possible effects of SCS
therapy on blood glucose metabolism. Therefore hyperinsulinemic euglycemic clamps with an
insulin infusion of 1mU / kg body weight per minute are performed. During the clamp the
investigators apply different SCS techniques in a randomly order. Insulinsensitivity is
determined at different time points.